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James Scott Bradley
James Scott Bradley
Sr. V.P. of Employee Benefits for Cook, Hall & Hyde, Inc. and an employee benefits expert specializing in developing creative solutions to managing healthcare costs.

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Posted in Business / Industries / Insurance

Three New Federal Healthcare Mandates Will Impact Healthcare Costs

Aug. 4, 2009 12:07 pm

American's with Disabilities Act (ADA) Amendments

    • Effective October 3, 2009 for all large and small groups.
    • Hearing Aids:

      • Coverage of hearing aids will be standard.
      • Dollar limits mirror Durable Medical Equipment (DME) and Prosthetics and vary by state and plan
      • Limited to one device as follows:

        • Connecticut every 12 months
        • New Jersey every 24 months
        • New York every 3 years 

 Mental Health/Substance Use Parity

    • Effective October 3, 2009 for large (51+ lives) groups.
    • The new law does not allow more restrictive financial requirements for mental health and substance use disorder coverage than for any other medical expense.
    • It specifically states that deductibles, copayments, coinsurance, and out-of-pocket expenses must be in parity.
    • A plan may still have an aggregate lifetime limit and an aggregate annual limit that is applied to both medical and mental health/substance use disorder benefits.
    • The law also prohibits treatment limits on mental health and substance use disorder benefits that are more restrictive than those of medical/surgical benefits. The law specifically requires the following limitations to be in parity:

      • Limits on frequency of treatment
      • Limits on number of visits
      • Limits on number of days of coverage
      • Other similar limits on the scope or duration of coverage.

 Michelle's Law

    • Effective October 9, 2009 for individual plans, large, and small groups.
    • Prevents dependent children covered under a group health plan from losing coverage if they are forced to take a medically necessary leave of absence from school

 
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